Different treatment

On a recent clinical placement I was saw a Malaysian patient in outpatient setting who presented 2 weeks post TKR. On initial assessment I was surprised to see how little movement he had in the knee, especially seeing as the range had decreased by over 20 degrees since his discharge from hospital. I asked if he had been doing his exercises and he claimed to have been doing them everyday and was able to demonstrate them adequately so I believed him. I worked hard to get more movement in the knee and by the end of treatment there was a large improvement. Then he admitted that he had not been doing his exercises at home because there was nobody to do it for him. I found this fairly annoying as I knew all the exercises he was meant to be doing did not require an extra person. I spent a few minutes going through the exercises with the patient and showing him he can do them all by himself and also explained why it is important to get the knee moving. I spoke to my supervisor and she said this was not uncommon for their culture.

The next time that I saw this patient his range had again reduced and once again he said that there was nobody at home to do it for him so he had not been doing his exercises. Usually I would think that we need to do everything we can for a patient and I would have gone in and once again used manual techniques to encourage improved range. However, on advice from my supervisor I did minimal ‘hands on’ techniques and instead made the patient do the exercises on his own with my guidance. There was a fair amount of improvement by the end of the session and I gave him a very detailed home exercise program to do. I did not get to see this patient again but I hope that his changed his attitude. This situation made me realise that our treatment needs to be adjusted to the patient and what is better for one patient may not be as good for another despite having the same presentation.